Management of Distal Fibular Fractures With Minimally Invasive Technique: A Systematic Review

Ankle fractures are extremely common, with isolated distal fibular fractures being the most common variant. The current gold standard in treating unstable distal fibular fractures is open reduction internal fixation. However, with potential risk of wound complications, minimally invasive techniques have been introduced. This systematic review was performed to evaluate the clinical and functional outcomes of varying minimally invasive techniques including minimally invasive plate osteosynthesis, intramedullary (IM) nailing, and IM screw fixation. A comprehensive English literature search on PubMed was performed yielding 543 studies. With specific study selection criteria, a total of 13 articles were selected. After studying the reference of each of the 13 studies, an additional 7 articles were included, resulting in a total of 20 studies reviewed. A total of 8 articles reviewed used IM nailing as the fixation of choice with a total of 211 patients. Of the 211 patients, 33 experienced complications. Six articles using minimally invasive plate osteosynthesis were reviewed with a total of 264 patients. Of the 264 patients, 39 experienced complications. IM screw fixation was used in 6 articles reviewed with a total of 219 patients. There were 30 cases of complications from the 132 patients. Additionally, mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores among all fixation types was 88.4 ± 3.40 whereas the mean Olerud and Molander Score among all fixation types was 76.7 ± 16.58. The results of this study indicate that minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates compared with traditional open reduction internal fixation.